NHS Dentistry and Oral Health Inequalities

Debate between Judith Cummins and Robbie Moore

Wednesday 25th November 2020 Westminster Hall

[Judith Cummins]

Of course, I welcome cross-party work on this. I am vice-chair of the all-party parliamentary group for dentistry and oral health. I would very much welcome the hon. Member as a member of the APPG, and look forward to sorting out dentistry, including NHS dentistry, once and for all, with a particular view to addressing the difficulties his constituents face.

I ask the Government to step in now and provide capital funding to invest in new ventilation equipment to help to reduce these fallow times. It is simply not good enough to say that dental practices must fund this themselves. We all know how precarious their funding is, and how hard it has been hit by the pandemic. This is a matter of public health, and it is the Government’s responsibility to safeguard and protect that. To avoid that responsibility would be a matter of gross negligence on the Government’s part.

In recent years, neither NHS England nor the Department of Health and Social Care has extended any capital funding to dental practices. The situation we now find ourselves in requires a change of approach. Local dentists have contacted me about the importance of maintaining temporary contract provisions that have been in place during the pandemic. Alan McGlaughlin, a dentist in my constituency, told me:

“Our fear is that NHS England may ask us to achieve more than the notional level of 20% of contracted targets for next year. This will be impossible due to allowable body flow in through the door and the cleaning and fallow periods required. I hope the NHS will allow for this issue and only then can we settle into a positive routine for the care of our patients.”

Can the Minister confirm that this target will not be increased, putting practices under impossible pressure?

Turning to secondary care, the pandemic has had a significant effect on waiting times for dental procedures in hospital. Thousands of children and vulnerable adults who require dental treatment under general anaesthetic are waiting in pain for treatment. There have been countless horrifying reports in recent months. The BBC has reported on a patient who suffered eyesight damage after not receiving treatment for a fractured tooth, which became an abscess. Meanwhile, the Daily Mail has reported the case of a seven-year-old girl who was left in severe pain for months after she was unable to get an appointment. Even before the pandemic, the waiting time for this kind of treatment was around one year. That is set to become significantly worse, given the backlog and reduced operating capacity.

I recently tabled a question asking for how many children planned dental admission to hospital has been suspended or cancelled since the start of the covid-19 outbreak. The Department responded that data was not available in the format requested. I find it simply unbelievable that the Department of Health and Social Care does not hold this information, so perhaps the Minister can answer that question. If she cannot do so today, I would welcome an answer later on.

As well as the pain and suffering that such delays cause patients, including problems eating, speaking and sleeping, they contribute to the impending public health crisis of resistance to antibiotics, as people require multiple courses of antibiotics while waiting for surgery. I understand that eight organisations, including the British Dental Association, Mencap, the Royal College of Surgeons, and the British Society of Paediatric Dentistry, wrote to the Secretary of State about this in mid-September, but have yet to receive a response, so would the Minister ensure that they receive a response as soon as possible?

I have focused on the practical problems that dentists and patients are facing as a result of the pandemic, but I would now like to turn to the effects that this is having on oral health inequalities. The covid pandemic has exacerbated socioeconomic, ethnic and regional inequalities across the country, and will worsen oral health inequalities too. According to the Association of Dental Groups, access to treatments for poorer patients has fallen by 39% over the past 10 years. Regions such as Yorkshire and the Humber have struggled for years with an acute crisis in access to NHS dentistry. I have raised this many times with various public health ministers, and while we have taken some small but important steps to improve things—especially when the hon. Member for Winchester (Steve Brine) was Minister—for which I am very grateful, the situation is still fundamentally inadequate.

Inequalities in access to dentistry inevitably lead to inequalities in oral health outcomes. A child in Yorkshire and the Humber is five times more likely to be admitted to hospital for a tooth extraction than a child in the East of England. In Bradford, 36% of children have tooth decay, compared with just 7% in the best performing area of the country.

[Robbie Moore (Keighley) (Con)]

I thank the hon. Lady for securing this debate. This has been a big issue for many of my constituents across Keighley and Ilkley, in terms of the outreach programmes that are done by dentists and hospitals, ensuring that those children with tooth decay get the appropriate education about how to treat and look after their teeth. Does she agree that the Government could provide more emphasis on that?

[Judith Cummins]

I absolutely agree that prevention work is key to solving much of our dental crisis, particularly for children. I am also concerned about the effect of the pandemic on the oral health of vulnerable groups, including pregnant women, people who have been shielding and people with dementia. They are highly unlikely to have received any dental care since March. Inevitably, problems will have built up. In the case of pregnant women, who under normal circumstances would be able to receive treatment for up to 12 months after the birth of their baby, will the Minister outline what provisions are in place to ensure they will be able to receive their NHS dental treatment free of charge despite the backlog in treatment?

Finally, I would like to make a few points about the long-term future of dentistry in this country. Dental practices across England—and with them the very fabric of dental care for millions of people—are facing an existential threat. We are at a crisis point for dentistry. Most British Dental Association members believe they can survive only for 12 months or less in the face of lower patient numbers and higher overheads. The Government could take several immediate steps to protect dental practices and improve oral health outcomes.

First, the Government should look at what immediate financial support can be given to dentists and dental practices. For instance, why are dentists among the only businesses on the high street that continue to pay business rates? Secondly, in terms of access to both primary and secondary care, dentistry is severely limited for the foreseeable future, and emphasis on investment in oral health and prevention is needed now more than ever.

The Government must now commit to investing in preventive schemes that are proven to work. That includes supervised tooth brushing for children, which the Government committed to consult on by the end of 2020. I would welcome the Minister’s assurance that that will still go ahead.

On the topic of prevention, I must mention the dental contract. For some time, there has been widespread, cross-party agreement that the dental contract needs reform. Units of dental activity have always been a poor way to measure meaningful dental health care. Their continued presence in the contract would be a disaster in the present circumstances. Despite the wider challenges the Government are facing, now is the right time to do this. Working with the BDA and others, Government must introduce a new contract that focuses on prevention, supports best patient care and improves access, especially for those who need it most.

I have spoken about the real challenges dentists are facing as a result of the coronavirus pandemic, but the problems in our dental health system reach back far beyond that. The pandemic has shown how fragile the system is and the effect on patients when it collapses. I urge the Government to invest in dentistry, prioritise prevention and work to close the inequalities that I have outlined. Anything less than that will let down the most vulnerable people, who need an NHS dental service that is fit for purpose.